Radiation Protection File by ra4z25


									Barrow Street Dental Practice                                                             January 2010

                          RADIATION PROTECTION FILE

Review Log

This Radiation Protection File will be reviewed periodically to ensure that it remains
relevant and effective. It will be reviewed at least annually.

This Radiation Protection File and its contents will be brought to the attention of those
directly involved with dental x-rays.

Local Rules
These are available in the radiation protection file and in each surgery pinned adjacent
to the x-ray machine.
The Local Rules must contain at least the following information:

         (a)      name of the appointed Radiation Protection Adviser
         (b)      name(s) of the appointed Radiation Protection Supervisor(s)
         (c)      the identification and description of each controlled area and a
                  summary of the arrangements for restricting access
         (d)      an appropriate summary of the working instructions
         (e)      identification or summary of any contingency arrangements indicating
                  the reasonably foreseeable accidents to which they relate
         (f)      the dose investigation level.

The local rules should be drawn up by the Legal Person in consultation with the
Radiation Protection Adviser.


Legal person’s (employer’s and/or practice owner’s) written
procedures for patient protection

Patient Identification

Where there is any possibility of the wrong patient being x-rayed (if the patient is
referred to another site or operator, for example), the patient will be asked to confirm
their name, address and date of birth.

Staff Appointments

The following staff have been authorised to act in the following capacities:

Referrer:                           all dentists

IRMER Practitioner:                 all dentists

                                       Justifying and authorising individual exposures

(Note: In most practices the referrer and the IRMER practitioner will be the same

The operator (below) is the person who carries out all (or part) of the practical aspects
of the exposure.

Operator:                      dentists (Peter Martin, Sarah O’Brien, Mzingaye Hove)

Operators with limited functions:

Operator:                      no dental nurses qualified
                               (restricted to dental nurses holding the Certificate in
                               Dental Radiography)

                                   Selecting exposure parameters and/or positioning
                                    the film, the patient and the tube head
                                   Effecting the exposure (pressing the button)
                                   Processing films
                                   Quality assurance, including exposing test objects as
                                    part of the QA programme.

Operator:                   receptionist/manager (Julie Woods), dental nurses
(Lesley Leonard, Lisa Malone, Deborah Lloyd, Jodie Wilde, Catherine Harris)

                                   Film processing.

The above staff have received the relevant training commensurate with their duties
and this is documented at the end of this Radiation Protection File.

Medico-Legal and other Third Party Exposures

The need for and usefulness of medico-legal and other third party exposures will be
considered before the exposure is justified and authorised.

The informed and written consent of the patient will be obtained before such an
exposure is carried out.

Justification of Exposure

Before justifying an exposure, the IRMER practitioner will take account of:

   (a)      the availability and findings of previous radiographs
   (b)      the specific objectives of the exposure in relation to the history and
            examination of the patient
   (c)      the diagnostic benefit to the patient
   (d)      the radiation risk associated with the radiographic examination
   (e)      the efficacy, benefits and risk of available alternative techniques having
            the same objective but involving no, or less, exposure to ionising radiation.

The benefit should outweigh the detriment of the exposure. The exposure would
normally be expected to provide new information to aid the patient’s management or

Authorisation of Exposure

Each radiograph will be recorded on the patient’s electronic record card by the
IRMER practitioner.

For digital records, it is the responsibility of the Legal Person to make the appropriate
recommendation as to how authorisation will be recorded.

Pregnant Patients

It is not normally necessary (except in the unlikely occurrence of a vertex occlusal
projection – see below) to enquire if a patient is or may be pregnant for the purpose of
taking a dental exposure because the pelvic area is not irradiated and the dose
involved is very small. However, a pregnant patient can be given the option of
delaying radiography if she is particularly concerned about any adverse effects and if
this will not be detrimental to her treatment. It is not necessary to use a lead apron
except in the circumstances referred to below

Lead Aprons / Irradiation of the Pelvic Area (eg Vertex Occlusal Projection)

If the radiographic examination is such that the pelvic area may be irradiated the
following action will be taken:

   (a)     the operator will ask the patient whether she is, or might be, pregnant and
           record the response
   (b)     if there is no possibility of pregnancy, the radiographic examination can
   (c)     if the patient is definitely, or probably, pregnant, the situation will be
           reviewed as to whether to defer the investigation until after delivery. If the
           examination is carried out, the foetal dose will be kept to a minimum
           consistent with the diagnostic purpose. In such situations the use of a lead
           apron is advised, principally because of the reassurance that it provides
   (d)     if the patient cannot exclude the possibility of pregnancy, she will be asked
           whether her menstrual period is overdue. If pregnancy cannot be excluded
           but her menstrual period is not overdue, the examination can proceed. If
           her period is overdue, the advice in paragraph (c) should be followed.

Quality Assurance

Each procedure within the QA programme will be checked by Peter Martin and
recorded on a six monthly basis.

Patient Doses

The representative patient dose will be assessed as part of each routine test. At
present these tests are carried out three-yearly. The diagnostic reference levels will be
reviewed by the Legal Person in the light of these findings. The ongoing QA
programme will ensure acceptable quality of radiographs.

Clinical Evaluation of Radiographs

Each radiograph will be evaluated in writing by the dentist treating the patient (or
prescribing treatment where the patient is treated by a therapist or a hygienist) and
provide information sufficient for a later audit. For example:

       (a)     caries can be charted
       (b)     only findings relevant to the patient’s management or prognosis need
               to be recorded
       (c)     for a pre-extraction radiograph record for example ‘root form simple’
               or ‘nothing abnormal diagnosed’.
       In the Exact programme, quality and notes are prompted and can be evaluated
       by later audit.

Accidental or Unintended Dose to Patients

The possibility of accidental or unintended dose shall be minimised by following the
standard operating procedures for exposure settings and by immediately releasing the
irradiation switch and switching off from the mains supply in the event of:

            an exposure failing to terminate after a pre-set condition

The Radiation Protection Supervisor and Legal Person shall be notified immediately
and the advice of the Radiation Protection Adviser sought.

Clinical Audits / Peer Reviews

Clinical audit and/or peer review will be provided for and carried out in accordance
with national arrangements. This will be carried out by Foundation Dentists as a part
of their training and a continuing quality audit will be carried out using the
computerised software, checked annually by Peter Martin.

Policy Updated:
6/11/10 by Peter Martin
18/3/12 by Peter Martin

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